What question did this study set out to answer?

To assess the timing of coronary angiography and revascularization in STEMI patients over an 11-year period.

January 10, 2026The Lancet Regional Health - Europe0 citationsOpen Access

Time to coronary angiography and revascularization in 575,247 patients with STEMI from 2012 to 2023: a retrospective population-based cohort study

PSPaulina Stürzebecher ULULRICH LAUFS PBPhilip Baum

Key Points

To assess the timing of coronary angiography and revascularization in STEMI patients over an 11-year period.
Conducted a retrospective analysis of 575,247 patients diagnosed with STEMI from 2012 to 2023

Structured PICO

Does shorter time to primary percutaneous coronary intervention reduce in-hospital mortality in adult patients with STEMI?

Population

575,247 adult patients with ST-elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (PPCI) in Germany, median age 64 years, 28.5% female.

Intervention

Shorter time to primary percutaneous coronary intervention (in-hospital time to angiography [IHTA] <40 min or time for transport to hospital [TTH] + IHTA <80 min)

Comparator

Longer time to primary percutaneous coronary intervention (IHTA 90-120 min or TTH + IHTA ≥120 min)

Outcome

Time intervals to PPCI (IHTA and TTH) and in-hospital mortalityhard clinical

In-hospital delays for STEMI care in Germany decreased significantly from 2012 to 2023, and shorter time to angiography was associated with reduced in-hospital mortality.

Abstract

Background: Rapid primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI) reduces in-hospital and long-term mortality. This study analyzes time intervals to PPCI in STEMI, risk factors for delay of PPCI, and in-hospital mortality from 2012 to 2023. Methods: This is a retrospective population-based analysis of hospital billing data of adult STEMI patients receiving PPCI in Germany. The time for transport to hospital (TTH) was estimated using geographic routing. The in-hospital time to angiography (IHTA) was calculated using time coding of PPCI in patient records. Findings: A total of 575,247 patients were included. The median age was 64 years, 28.5% (164,016) were female. The population with IHTA ≤60 min increased from 44.5% (22,240/49,965) in 2012 to 57.7% (24,434/42,356) in 2023 with improved TTH + IHTA ≤120 min (56.6%, 28,280/49,965, in 2012-70.2%, 29,734/42,356, in 2023). IHTA improved from median 73.1 min (IQR 25.2-186.6) in 2012 to 46.4 min (IQR 17.5-111.6) in 2023 with a stable TTH (11.4-11.9 min). Risk factors for an IHTA >60 min included age, female sex, comorbidity, presentation out of regular hours, and low-volume hospitals. In-hospital mortality increased (8.8%, 4406/49,965, in 2012, 10.4%, 4822/46,203, in 2021, 10.1%, 4272/42,356, in 2023), paralleling a rise in patient age and comorbidity. Risk factors for in-hospital mortality included female sex, increased age, comorbidity, high-volume hospitals, intervention of multiple coronary arteries, weekend admission, and presentation out of regular hours. IHTA <40 min (90-120 min as reference) and TTH + IHTA <80 min (≥120 min as reference) reduced the risk of death. Interpretation: Combining hospital billing records with geographic routing enables benchmarking of both pre- and in-hospital delays in STEMI care. In hospital delay decreased between 2012 and 2023. Important areas for improving time delays and STEMI-related mortality include the timeliness of care outside of regular hours and a focus on women, older patients, as well as individuals with comorbidities. Funding: There was no funding for this project or this publication.

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